Research supports extended patching for stubborn childhood amblyopia

Children with stubborn amblyopia, also known as "lazy eye," have new hope for better outcomes thanks to recent research.

"We now have clear evidence to support the practice."

Increasing patching from two to six hours a day effectively treats persistent amblyopia, according to a study from the Pediatric Eye Disease Investigators Group (PEDIG). The study was published in Ophthalmology (available as a paid download).

"We really didn't know what to do when a child stopped improving after patching two hours a day," said David K. Wallace, M.D., professor of ophthalmology and pediatrics, Duke University School of Medicine, and lead author of the report. "With this study, we now have clear evidence to support the practice of increasing the duration of patching to six hours a day for stubborn amblyopia."

Patching is the standard treatment for amblyopia, according to the National Eye Institute, which funded the research. Eye care practitioners often increase the daily duration if children stop making progress. But until now, there was limited evidence to show this approach actually works.

"I am happy to see additional research and guidance coming from PEDIG," said Maria Richman, O.D., chair of the AOA Vision Rehabilitation Center. "As optometry has been the primary provider of amblyopia management for years, the information provided will definitely be a welcome resource to complement the AOA Clinical Practice Guideline on Amblyopia."

What the study showed

Researchers enrolled 169 children between ages 3 and 8 with persistent amblyopia in a clinical trial. One treatment group continued with two hours of daily patching, and another increased daily patching to six hours.

After 10 weeks, children in the six-hour patching group could see an average of 1.2 additional lines on an eye chart with the affected eye. Children in the two-hour patching group improved on average only 0.5 lines. Perhaps even more compelling, 40 percent of children in the six-hour group saw two or more lines of improvement.

The report outlines an evidence-based, staged approach for treating amblyopia:

  • The first stage is wearing eye glasses with prescription lenses, if needed, to correct vision as much as possible.
  • Patching for two hours a day-or using eye drops or lens filters that blur vision in the better eye-is recommended if amblyopia persists after 10 weeks of wearing glasses.
  • If amblyopia persists after 10 weeks with two-hour daily patching, PEDIG recommends children patch for six hours per day.

Once children reach maximum visual acuity, the report recommends monitoring them for recurrence.

October 7, 2013

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